The practice of acupuncture originated in China 5,000 years ago. Today it is widely used throughout the world and is one of the main pillars of Chinese medicine.

There are many different varieties of the practice of acupuncture, both in the Orient and in the West. Traditional Chinese medicine (TCM) usually combines acupuncture with Chinese herbs. Classical acupuncture (also known as five element acupuncture) uses a different needling technique and relies on acupuncture independent of the use of herbs. Japanese acupuncture uses smaller needles than the other varieties. Medical acupuncture refers to acupuncture practiced by a conventional medical doctor. Auricular acupuncture treats the entire body through acupuncture points in the ears only. Electroacupuncture uses electrical currents attached to acupuncture needles.

Aside from needles, other methods of stimulation are also considered forms of "acupuncture." These include the use of heat from the burning of herbs placed on specific points ("moxibustion") and the placement of herbal pastes on specific points.

Research on the effectiveness of acupuncture has special challenges. These include the diversity of approaches, the practice of individualizing treatment for each patient, differing skill levels between practitioners, and difficulty separating out the effects of acupuncture from placebo effects (i.e., how the patient's beliefs and expectations affect his/her perception of symptoms).

Based on acupuncture's long history of use as well as the limited research available, both the World Health Organization and the National Institutes of Health have identified many conditions for which it may be recommended. However, many common uses do not yet have formal scientific evidence to support them.

Chinese medicine theory holds that the human body contains a network of energy pathways through which vital energy, called "chi" (also spelled "qi"), circulates. These pathways are called "meridians."

The meridians contain specific "points" that function somewhat like gates or way stations through which chi flows as it circulates through the body. Acupuncture needles are inserted into these points to regulate the flow of chi through the meridians.

Illness and symptoms are believed to be caused by problems in the circulation of chi through the meridians (e.g., blockage or impairment of proper flow). Good health is considered an indication of the proper circulation of chi - a state of "balance" or "harmony."

Chi is believed to have subtle qualities (sometimes referred to as "elements"), which can be in balance or out of balance, causing symptoms.

Western science has determined that the meridians and points identified in Chinese medicine coincide with anatomical features that can be observed with scientific instruments. For example, electrically-charged particles called "ions" have been found to flow through "ionic streambeds" that correspond with the meridians just beneath the surface of the skin. Acupuncture points have been found to emit light, which can be detected with sensitive laboratory equipment.

The chi proposed by Chinese medicine theory is not electricity and is not directly detectable with scientific instruments. Western science has studied electrical phenomena (ions, electrons, electrical energy) that occur with acupuncture. These phenomena are detectable and appear to accompany the circulation of chi through the body.

Acupuncture has been shown to effectively treat some health conditions, including pain. However, the mechanism of action remains unclear. Endogenous opioid-mediated mechanisms of electroacupuncture as used in China only appear to explain how acupuncture works in part. Acupuncture is purported to also affect the brain's reward systems as well as blood flow in the skin, muscles, and nerves. Research has also shown regional effects on neurotransmitter expression.

One of the challenges in reviewing acupuncture and other complementary practices is the lack of placebo or sham-groups in most clinical trials. Some experts argue that blinding and placebo controls are not necessary, since when they are used, they are often not true shams. Recent study investigated a sham retractable type acupuncture needle and found that the applicability of "placebo" needling may be influenced by inter-tester variability, as well as the patient's knowledge and experience of acupuncture, acupuncture point selection, the visual impact of needling, and so on.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

There has been substantial research on the efficacy of acupuncture in the treatment of osteoarthritis. Most studies focus on knee, cervical, and hip osteoarthritis symptoms. In recent years, the evidence has improved and is now considered strong for the use of acupuncture in osteoarthritis of the knee.

A

Strong evidence supports the use of acupuncture in long-lasting back pain and neck pain.

A

Several studies have tested the effects of acupuncture on pain after surgery. A clear majority of these studies have reported beneficial effects.

A

Results of acupuncture in postoperative dental pain have been promising and supported by numerous studies.

B

There is good evidence from several studies supporting the use of acupuncture to reduce pain and discomfort during endoscopy or gastroscopy.

B

There is evidence from several studies suggesting that acupuncture may help with pain relief in fibromyalgia. Some research suggests it may also improve symptoms of fatigue and anxiety.

B

Evidence from several small studies supports the use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting. Electroacupuncture has also been used in combination with anti-nausea medications.

B

Evidence supports the use of acupuncture at the wrist P6 point for the relief of post-operative nausea and vomiting in adults. Some research has shown that acupuncture is equally as effective as anti-nausea drugs.

B

Acupuncture may regulate metabolic disorders of lipids and improve main clinical symptoms in patients with cerebral infarction and hyperlipidemia. Better-designed trials are needed to confirm these results.

C

Based on the possible pain-relieving effects of electroacupuncture, this therapy has been suggested as a possible form of anesthesia. Limited research has tested its anesthestic effects in patients undergoing heart surgery. More research is needed to determine if this is a safe and effective treatment.

C

Some research has suggested that acupuncture might help reduce distress and symptoms of angina, but this has not been consistently shown in other studies.

C

Based on limited research, acupuncture combined with motor therapy may help treat ankylosing spondylitis, an inflammatory disease of the spine and nearby joints.

C

There is not enough evidence to recommend for or against the use of acupuncture in patients with annexitis (inflammation of the uterus).

C

Several studies suggest that acupuncture may help improve symptoms of anxiety, especially before surgical or diagnostic procedures. However, the sum of the evidence is conflicting.

C

Some research suggests that acupuncture may help prevent exercise-induced asthma. It may also reduce the perceived level of breathlessness associated with asthma or emphysema and allow patients to take lower doses of asthma medications. However, the available studies are insufficient for making strong recommendations.

C

Early research suggests that a combination of electroacupuncture and behavioral or educational therapy may help improve symptoms of autism. However, acupuncture did not improve intelligence. More research is needed to confirm these early findings.

C

Acupuncture plus Methycobal® has been studied as a possible treatment for diabetic neurogenic bladder. This condition occurs when a problem with the nervous system prevents people from properly controlling their bladders. More research is needed to determine if acupuncture is effective for this disorder.

C

Hand acupuncture has been compared to moxibustion in relieving pain in women who have undergone hysterectomies; however, it is impossible to reach a firm conclusion at this time.

C

Researchers have tested the effects of acupuncture-moxibustion on multiple aortitis, a condition that causes the main blood vessel (called the aorta) to swell. Although acupuncture-moxibustion was shown to be more effective than standard medications, more research with acupuncture alone is needed before a firm conclusion can be made.

C

Early research suggests that acupuncture or electroacupuncture may help treat vasomotor symptoms, such as hot flashes, in breast cancer patients. More study is needed before a strong recommendation can be made.

C

Early research suggests that acupuncture may improve breast milk flow in women who do not produce enough milk after delivery. More research is needed in this area.

C

There is insufficient evidence to recommend for or against the use of acupuncture in pain associated with burns.

C

There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits.

C

Acupuncture has been found to be superior to medication (shenmai injection) for low pulse pressure syndrome. More studies are needed before a firm conclusion can be drawn.

C

Currently, there is insufficient evidence available to recommend for or against the use of acupuncture in carpal tunnel syndrome.

C

There is not enough evidence available from well-designed studies to recommend either for or against the use of acupuncture in cerebral palsy. Many studies combined acupuncture with rehabilitation therapies, such as motor therapy.

C

Both needle-knife therapy and acupuncture have been used to treat cervical spondylosis, with one study showing needle knife therapy as a superior treatment. However, higher-quality studies are needed before strong recommendations can be made.

C

It is unclear if acupuncture can help increase white blood cells (called leukocytes) in cancer patients who are receiving chemotherapy. Well-designed research is needed in this area.

C

There is not enough available evidence to recommend either for or against the use of acupuncture in nervous system disorders that affect brain functioning or communication.

C

Early study has used acupuncture for acute and chronic colitis. More study is needed before a strong recommendation can be made.

C

The combination of acupuncture and Schuell's stimulation and psychological care may be effective in treating aphasia due to cerebrovascular disorders. Additional study is needed in this area.

C

Overall there is insufficient evidence on which to base strong recommendations for acupuncture to treat breathlessness in patients with COPD.

C

There is not enough evidence to recommend the use of acupuncture in the treatment of vascular dementia.

C

There is some evidence to suggest that acupuncture may help treat symptoms of depression, especially in menopausal or stroke patients. Study results are mixed. More studies are needed before a strong recommendation can be made.

C

There is a lack of well-designed studies to determine the effect of acupuncture in this condition.

C

There is promising research that acupuncture may be an effective therapy for diabetic retinopathy, an eye disease that may lead to vision loss. However, additional studies are needed before a recommendation can be made.

C

Acupuncture therapy has been suggested as a possible treatment for the side effects associated with various diagnostic procedures. More research is needed in this area.

C

There is some limited evidence suggesting that acupuncture may stimulate salivary flow in some patients with dry mouth (xerostomia). More studies of better design are needed to evaluate this use.

C

It is unclear if acupuncture can improve symptoms of painful menstruation. Study results are mixed. Additional research is needed before a conclusion can be made.

C

Currently, there is not enough data to recommend for or against the use of acupuncture in functional dyspepsia.

C

The available studies do not offer enough evidence to make a strong recommendation.

C

The use of acupuncture as a treatment for epilepsy has aroused researcher interest because many patients have difficulty controlling their seizures despite antiepileptic treatments. Limited evidence does not support acupuncture as a treatment for epilepsy, but more studies are needed in this area.

C

There is insufficient available evidence to recommend for or against acupuncture in the treatment of erectile dysfunction.

C

It is unclear if acupuncture can improve muscular performance, muscle strength, or heart rate recovery after exercise. Additional research is needed to determine if acupuncture is an effective therapy for exercise performance.

C

Early evidence has shown that eye-needling combined with medication may be more effective than medication alone in the treatment of ophthalmoplegia, a condition that causes paralysis of the motor nerves of the eye.

C

Acupuncture has been studied as a possible therapy for facial paralysis. Additional studies are needed before recommendations can be made.

C

Fasciitis is inflammation of the layer of connective tissue that covers, separates, and supports muscles. Acupuncture has been studied in fasciitis of back muscles. More studies are needed to make any firm conclusions.

C

Early research suggests that acupuncture may help reduce a high fever associated with the common cold. More research is needed to confirm these early findings.

C

Early evidence suggests that acupuncture may help treat gastroparesis, which refers to nerve or muscle damage in the stomach that causes slow digestion and emptying, vomiting, nausea, and bloating. More research is needed in this area.

C

Acupuncture may offer promise for various types of headaches, but higher quality studies are needed before recommendations can be made.

C

Hemiplegia is a condition of full or partial paralysis of one side of the body due to disease, trauma, or stroke. Various types of acupuncture, such as scalp acupuncture and traditional acupuncture, have been used to treat hemiplegia. Although early research is promising, more studies are needed before a recommendation can be made.

C

Limited evidence indicates that acupuncture may benefit patients with cerebral hemorrhage or submucosal hemorrhage of the vocal cords. Study of acupuncture's effects alone vs. in combination with other therapies may help make a firm conclusion.

C

Based on early research, acupuncture therapy may help treat herpes zoster and improve symptoms of pain. However, more high-quality studies are needed before a conclusion can be made.

C

There is insufficient evidence available on which to base any recommendation for or against the use of acupuncture in high blood pressure.

C

It is unclear if acupuncture has beneficial effects on hormone levels in patients with Sjogren's syndrome or partial androgen deficiency of aging (PADAM). More research is needed in this area.

C

More studies are needed to determine the benefits of acupuncture on infertility.

C

Traditional Chinese medicine commonly uses acupuncture to treat insomnia. A review of the available studies found reports of benefit, but major weaknesses in the design of the research makes the evidence insufficient to recommend for or against acupuncture for insomnia.

C

Although limited evidence suggests benefit may be possible, more studies are needed in order to make recommendations for or against acupuncture in IBS.

C

There is not enough evidence on which to base recommendations for keratoconjunctivitis sicca at this time.

C

There has been limited research on acupuncture for kidney disorders, such as gouty renal damage or kidney hypertension of long-lasting (chronic) kidney disease. There is currently not enough available evidence to recommend for or against the use of acupuncture in these conditions.

C

Acupuncture has been studied as a treatment for mastitis in breastfeeding women. Researchers have found that acupuncture may have beneficial effects when combined with standard treatment. More research is needed in this area.

C

There has been limited research on acupuncture for menopausal symptoms, such as hot flashes and menopause-related high blood pressure. However, because results are mixed, more studies are needed before a conclusion can be made.

C

A limited amount of research suggests that acupuncture may increase leg strength. Additional studies are needed.

C

Early research suggests that acupuncture may help reduce myofascial pain. However, additional studies are needed to confirm these findings.

C

Acupuncture may be effective in reducing the occurrence of nonspecific nausea. Additional studies are needed before a strong recommendation can be made.

C

Several attempts have been made to document the benefits of stimulation of the P6 wrist point to reduce post-operative nausea and vomiting. Both acupuncture and acupressure wristbands have been tried. Study results are mixed. More trials are needed to make any firm conclusion regarding the use of acupuncture in adults and children.

C

It is unclear if acupuncture can help treat nausea and vomiting of pregnancy. Additional studies are needed in this area.

C

It is unclear if acupuncture can help treat nerve damage. More research is needed in this area.

C

There is insufficient evidence available on which to base recommendations for or against acupuncture in craniofacial pain.

C

There is not sufficient evidence available on which to base recommendations for or against acupuncture in Parkinson's disease.

C

Based on early study results, acupuncture may have a beneficial effect on peptic ulcers. However, a conclusion cannot be made until more studies are performed.

C

Acupuncture and electroacupuncture may help prevent and reduce symptoms in patients with polycystic ovary syndrome. However, further research is needed before a firm recommendation can be made.

C

It is unclear if acupuncture is beneficial for patients with post-traumatic stress disorder (PTSD). Early study results are promising, but larger studies are needed in this area.

C

Early evidence suggests that acupuncture may substantially reduce low back pain in pregnancy. More studies are needed to confirm these results.

C

Acupuncture has been reported to encourage uterine contractions during labor and to reduce the pain of labor. However, results of formal studies are mixed, and the research designs have been weak. More studies are needed to clarify the potential of acupuncture in labor.

C

Moxibustion has been used historically in acupuncture to correct cephalic version (breech presentation) by turning the fetus' head in utero. Further studies are needed to determine its role in the correction of breech presentation.

C

While limited evidence suggests benefit may be possible, there is insufficient available evidence to recommend either for or against acupuncture in prostatitis.

C

While limited evidence suggests benefit may be possible, there is insufficient available evidence to recommend either for or against acupuncture in uremic cutaneous pruritus.

C

There is insufficient evidence on which to base recommendations for the use of acupuncture in Raynaud's syndrome at this time.

C

While limited evidence suggests benefit may be possible, there is insufficient available evidence to recommend either for or against acupuncture in prolapsed rectums.

C

Few studies have tested the use of specific therapies, separate from herbal or oral supplements, in rehabilitation of the heart. It remains unclear if acupuncture is an effective treatment.

C

Some studies of weak design have reported that acupuncture may relieve pain associated with rheumatoid arthritis. However, a well-designed trial was unable to confirm this. More evidence is needed to clarify if or when acupuncture is beneficial in rheumatoid arthritis.

C

There is not enough available evidence on which to base recommendations for acupuncture in patients with rhinitis.

C

The available research on acupuncture for shoulder pain of varying causes shows mixed results.

C

More studies are needed of stronger design to determine whether or not acupuncture offers benefit in sinusitis.

C

There is evidence from several studies suggesting that laser acupuncture therapy may be beneficial for skin conditions. However, due to weaknesses in study methods, as well as the wide variety of conditions (such as psoriasis) in this category, it is difficult to make specific recommendations.

C

Some evidence suggests that acupuncture may help improve breathing in patients with moderate obstructive sleep apnea. Additional studies are needed to confirm these early findings.

C

Scalp acupuncture combined with rehabilitation training may help improve symptoms of aphasia, a condition that occurs when a person has difficulty understanding and/or producing spoken and written language. More research is needed in this area.

C

Several studies have been conducted in stroke rehabilitation. More studies are needed to determine what can be expected in the use of acupuncture with regard to this application.

C

The evidence on acupuncture in treating substance abuse is mixed. More studies are needed to evaluate the use of acupuncture in this application.

C

The available evidence suggests acupuncture may be comparable to other forms of conservative treatments. However, the studies that have been performed have major weaknesses that call into question the meaning of the findings. More studies of better design are needed for definitive recommendations.

C

Evidence suggests that there is a reduction of pain and an improvement of function in the afflicted elbow.

C

Based on early evidence, acupuncture may be an effective therapy for Tourette's syndrome. Further research is needed to confirm these results.

C

Currently, there is insufficient available evidence to recommend either for or against acupuncture in primary trigeminal neuralgia.

C

Early study in women suggests a reduced recurrence over six months and reduced residual urine (urine retained in the bladder after voiding). Better-designed studies are needed to determine recommendations for this use.

C

Both ginger moxibustion and acupuncture have been studied for cervical vertigo, although few conclusions can be drawn at this time.

C

Acupuncture has been combined with other therapies, such as massage, manual therapy, and Chinese medicine, to treat vision problems, including nearsightedness, optic atrophy, and visual recovery. Additional studies with acupuncture alone are needed before any conclusions can be made.

C

Subjective observations in one small study suggest a possible role of acupuncture in the treatment of vulvodynia symptoms (chronic burning or stinging sensation of the vulva in the vagina). However, there is currently not enough evidence on which to base recommendations.

C

Evidence is inconsistent on whether acupuncture might contribute to weight loss. Some studies show modest benefit but others show none. Currently, there is not enough available evidence to recommend either for or against acupuncture in weight loss.

C

Early evidence suggests that acupuncture is not effective in treating hearing loss in adults or children.

D

Numerous studies of acupuncture for smoking cessation have been conducted, and the quality of studies has varied widely. Results have been inconsistent. Several critical reviews of the research have concluded that the evidence does not support acupuncture as a reliable or effective method for smoking cessation. There may, however, be some benefit in reducing side effects of withdrawal such as irritation, cigarette craving, and headache.

D

Small trials have been conducted and found no benefits over placebo for the treatment of chronic unilateral or bilateral tinnitus. However, non-controlled case series have found possible benefit. Larger studies are needed before a strong recommendation can be made.

D

Early study does not show that laser acupuncture is any more effective than sham laser acupuncture when used in combination with drugs and other mobilization therapies. More study is needed in this area.

D

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Safety
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Acupuncture does not usually cause serious side effects. There have been reports of dizziness and rapid, involuntary eye movements after acupuncture. Needles must be sterile in order to avoid disease transmission or infections (most practitioners now use disposable needles). Acupuncture should only be performed by qualified healthcare professionals. A woman who tried to perform acupuncture on herself experienced a spinal cord injury after inserting a sewing needle into her spinal cord.

Rare side effects include collapsed lung (called pneumothorax), blood clots (which may block blood vessels), ruptured artery (called a pseudoaneurysm), bleeding, abscesses, cerebrospinal fluid fistula, and diabetic ketoacidosis. A case of Bell's palsy has occurred after acupuncture. Symptoms went away two weeks after therapy was stopped, but it is unclear if acupuncture caused the condition.

Acupuncture should be avoided in the following conditions: valvular heart disease, known bleeding disorders, use of anticoagulants (blood thinners), pregnancy (may induce unwanted labor and possible miscarriage), systemic or local infection, pain of unknown medical origin, medical condition of unknown origin such as dermatologic lesions, and neurologic disorders (e.g., severe polyneuropathy or paraplegia, or following certain forms of neurosurgery) as well as on areas that have received radiation therapy.

Caution is advised in patients with pulmonary disease, elderly or medically compromised patients, diabetics (due to poor circulation), and in patients with a history of seizures. Wrist-ankle acupuncture may improve metabolism of blood sugar and blood-lipids, and a healthcare provider should monitor these levels in diabetic patients as medication adjustments may be necessary.

Electroacupuncture should be avoided in people with arrhythmia or pacemakers.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.